Family Medicine最新文献

The current political and social climate is directly and indirectly impacting the work-life wellness of family medicine faculty who are underrepresented in medicine (URiM). Furthermore, issues of social justice are an intimate part of the lived experience of URiM faculty physicians and cannot be ignored. Institutional programs and offices that have traditionally served to support URiM faculty-namely diversity, equity, and inclusion (DEI) offices and programs-are actively being dismantled through anti-DEI legislation across the country. Where do such changes leave URiM faculty in terms of career advancement and support? Studies show that mentorship is necessary and effective in URiM faculty development. Despite the gains through mentorship, gaps in the support of URiM faculty are obstacles to their reaching their highest potential. Obstacles such as pseudoleadership, scholarship delay, minority taxation, and income inequality make succeeding at their institution more difficult for these faculty members. These hurdles confound the reality that URiM faculty physicians tend to have value systems surrounding their own self-actualization, family structure, and professional development that differ from institutional priorities. Lack of awareness of these differences in mentorship needs has negative consequences for the growth and advancement of both URiM faculty and their institutions. Prioritization of effective mentorship strategies is necessary to bridge the value differences and overcome the obstacles that will ultimately benefit both the institutions and their URiM faculty. This article defines the gaps in mentorship of URiM faculty, introduces strategies for closing the mentorship gaps, and summarizes how doing so produces gains on a systemic level.

Background and objectives: The family medicine clerkship has been found to influence medical students' decision-making regarding specialty choice. Understanding how the family medicine clerkship has changed over the past decade may assist in recruitment efforts. Our study explored trends in family medicine clerkship design, length, and format and correlated these characteristics with high proportions of medical school graduates choosing family medicine.

Methods: We performed a secondary analysis of the Council of Academic Family Medicine Educational Research Alliance annual family medicine clerkship director surveys from 2012 to 2023. We analyzed standard family medicine clerkship structure questions that were asked in each survey. We analyzed trends using Pearson's correlation coefficient test and correlations with χ2 test for independence.

Results: Over the past 10 years, a transition from traditional block-style clerkships toward longitudinal-style clerkships has been increasing. Both block-style and longitudinal-style clerkships have decreased in length, with most clerkships lasting 4 weeks or less. A change also has taken place in the composition of clinical experiences, with reduced use of community preceptors as the primary source of clinical experiences. In 2021, schools with a higher percentage of students working with community preceptors were associated with higher percentages of medical students choosing to pursue family medicine.

Conclusions: Alterations in the family medicine clerkships have led to medical students getting decreased and intermittent exposure to family medicine. Most clerkship experiences are not with community preceptors, a major change following the COVID-19 pandemic. The repercussions of recent changes to the family medicine clerkship on the rate of matching medical students into family medicine remains unclear.

Background and objectives: Although artificial intelligence models have existed for decades, the demand for application of these tools within health care and especially medical education are exponentially expanding. Pressure is mounting to increase direct observation and faculty feedback for resident learners, which can create administrative burdens for a Clinical Competency Committee (CCC). This study aimed to assess the feasibility of utilizing a large language model (ChatGPT) in family medicine residency evaluation by comparing the agreement between ChatGPT and the CCC for the Accreditation Council for Graduate Medical Education (ACGME) family medicine milestone levels and examining potential biases in milestone assignment.

Methods: Written faculty feedback for 24 residents from July 2022 to December 2022 at our institution was collated and de-identified. Using standardized prompts for each query, we used ChatGPT to assign milestone levels based on faculty feedback for 11 ACGME subcompetencies. We analyzed these levels for correlation and agreement between actual levels assigned by the CCC.

Results: Using Pearson's correlation coefficient, we found an overall positive and strong correlation between ChatGPT and the CCC for competencies of patient care, medical knowledge, communication, and professionalism. We found no significant difference in correlation or mean difference in milestone level between male and female residents. No significant difference existed between residents with a high faculty feedback word count versus a low word count.

Conclusions: This study demonstrates the feasibility for tools like ChatGPT to assist in the evaluation process of family medicine residents without apparent bias based on gender or word count.

Background and objectives: Primary care physicians are well-positioned to be at the forefront of screening for and treating substance use disorders (SUDs). In addition, the Accreditation Council for Graduate Medical Education has deemed addiction training a common program requirement for all residency programs. With less than one-third of family medicine residency programs providing addiction training, understanding best practices for addiction training is important.

Methods: We interviewed 12 faculty at family medicine residency programs across the country who have a strong reputation for addiction training. We analyzed interview transcripts thematically to identify best practices for creating and providing addiction curricula.

Results: Creating an addiction curriculum originates with an addiction champion who garners the support of clinical leadership and provides faculty development that is augmented by a multidisciplinary team of providers, often grant-supported. Coupling didactic learning with a wide array of experiential opportunities is important, particularly allowing residents to care for patients with SUDs longitudinally in their primary care clinics. Residency programs should anticipate stigma and associated resistance from clinic staff and providers and should work collaboratively to mitigate these.

Conclusions: Comprehensive and robust addiction training in family medicine residency training should include didactic and experiential learning opportunities with a well-supported and philosophically aligned clinical and educational culture that values caring for patients with SUDs.

Background and objectives: Despite the widespread adoption of the holistic review initiative in medical school admissions, admissions committees continue to struggle with identifying applicant attributes that predict future practice location. This challenge has significant practical implications, particularly for institutions committed to addressing regional health care shortages.

Methods: We analyzed eight cohorts of applicants who matriculated between 2006 and 2013 and then completed residency. We used univariate and multiple regression models to identify applicant objective attributes linked to later in-state practice. Objective data available in applications included high school location, legal state of residence, Medical College Admissions Test (MCAT) scores, grade point average, college details, graduate school, race/ethnicity, and gender; these were compared by posttraining practice location.

Results: Of 509 graduates in practice, 212 (41.7%) were in-state. In-state graduates were older (P<.001), predominately underrepresented in medicine (42% vs 33%, P<.01), graduated from urban high schools (28% vs 18%, P<.05), attended in-state colleges (66% vs 55%, P<.05), and had lower MCAT scores (56th vs 67th percentile, P<.001). Regression analysis revealed that only age, urban high school, and MCAT score significantly contributed to the model (R 2=0.064, P=.004).

Conclusions: This study shows the limited value of applicant objective data to admissions committees in predicting future in-state practice. The findings emphasize the importance of a holistic admissions process and the value of considering subjective applicant data in efforts to predict future practice location. Additional research may help identify which subjective aspects of an applicant can assist admissions committees in this effort.

Background and objectives: Population health management is a systematic approach to ensuring that all members of a given population receive appropriate preventative, chronic, and transitional care. It emphasizes addressing health inequities and the social determinants that influence health and related outcomes in communities served by family physicians. This study examines the current practices of family medicine residency programs in teaching population health management and the use of clinical data registries for their primary clinic sites.

Methods: Data were collected through a survey conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA) from September 26 to October 30, 2023. The survey targeted program directors of Accreditation Council for Graduate Medical Education accredited family medicine residency programs, with a final response rate of 37.90% (271/715).

Results: We found significant variability in the clinical data registries and population-based reports provided to residents. Of the residency programs, 29.52% provided both resident-specific and practice-level panel data, while 12.92% did not provide regular data reports. Clinical quality and patient satisfaction were the most common elements in reports. Programs varied in the frequency and dedicated time for population health management, with many programs citing resource constraints.

Conclusions: The findings highlight the need for standardized education and clinical systems to integrate population health into resident training. Ensuring consistent, accurate, and actionable data can enhance the quality and value of care and prepare residents for future practice in value-based care environments.